The effectiveness of trunk stabilization exercise combined with vibration for low back pain in adolescents

Vibration is increasingly being used as a form of adjuvant therapy to relieve pain and improve functioning in adult low back pain (LBP) patients. Vibration stimulation can change the pattern of muscle activity and thus improve and strengthen the mobility of various elements of the skeleton, including the lumbar spine (LS), relieving LBP. Backache is most often associated with adults and, despite the large number of teenage patients complaining of LBP, they are not addressed in the social or scientific literature. Consequently, Korean researchers from the University of Gimcheon have investigated the effects of standard trunk stabilization exercises in conjunction with vibrotherapy on pain, proprioception and LS mobility during sit to stand (STS) bending in adolescent patients with LBP. The obtained results indicate the beneficial effects of vibrotherapy, suggesting its inclusion in LBP therapy in adolescent patients.

The vibrations increased the effectiveness of the trunk stabilization exercises. After 12 weeks of training, compared to the measurements before the start of the intervention, the following was observed:

• reduction of pain intensity, both in the placebo group (exercise without vibration) and in the vibration group (exercise + vibration), but in the vibration group much more effectively (by -2.20 ± 1.00 points) than in the placebo group (by -1.54 ± 1.14 points);
• increased trunk proprioception, both in the placebo and vibration group, but much more effectively in the vibration group (position change error decreased by -1.32 ± 0.56 °) than in the placebo group (-0.64 ± 0.57 °);
• greater improvement in LS mobility, including maximum range of motion and mean angular velocity of LS, which increased significantly more in the vibration group (mean change: 9.77 ± 3.34 ° and 6.14 ± 6.28 °/s, respectively) in compared to the placebo group (mean change: 5.13 ± 2.79 ° and 2.10 ± 5.29 °/s, respectively).

Prepared on the basis of:

The Effectiveness of Trunk Stabilization Exercise Combined with Vibration for Adolescent Patients with Nonspecific Low Back Pain. Jung KS et al. Int J Environ Res Public Health. 2020 Sep 25;17(19):7024.

Study population

Fifty adolescent (10-19 years old) patients with nonspecific LBP were recruited and randomized into two groups: vibration group (exercise + vibration; n = 25) and placebo group (exercise without vibration; n = 25). Subjects suffered from LBP for at least 3 months (visual analogue score ≥ 3; able to perform STS flexion without assistance). There were exclusion criteria established:

• severe osteoporosis or severe cardiovascular disease;
• progressive endocrine or nervous disease;
• previous experience with vibration training;
• medical history of fracture or surgery in the last 2 years;
• LBP caused by a specific disease.

Test procedure

Patients were assessed by 3 well-trained physiotherapists who were not informed about the purpose of the study. It was done before and 1-2 days after the intervention. All patients underwent 36 training sessions consisting of six exercises each. A single session lasted 25 minutes and was used once a day, 3 times a week, for 12 weeks. Patients in the vibration group performed standard trunk stabilization exercises with vibration stimulation, while those in the placebo group received trunk stabilization exercises without vibration stimulation.

All patients were asked not to engage in any form of exercise other than that related to the experiment during the study period.

Use of vibration in the study

Referring to previous studies on trunk stabilization exercises, in the presented study vibrations with a frequency of 15 Hz were used. The amplitude was set to 2 mm.

Results

Pain intensity

In both groups, a decrease in pain intensity as measured by the Numeric Pain Rating Scale (NPRS) was observed after the intervention. In the vibration group, however, the mean change was significantly deeper (by -2.20 ± 1.00 points in relation to the measurements before the start of training) than in the placebo group (by -1.54 ± 1.14 points in relation to the measurements before the start of training; p <0.05).

Trunk proprioception

In both groups, an increase in proprioception as measured by the range of position error was observed after the intervention. However, the mean change in the vibration group was significantly deeper (the position change error decreased by -1.32 ± 0.56 ° compared to the measurements before the start of training) than in the placebo group (-0.64 ± 0.57 ° compared to the measurements before the start of training; p <0.05).

The mobility of the LS during STS flexion

During the STS flexion phase, the maximum range of motion and the mean angular velocity of the LS increased significantly more in the vibration group (mean change: 9.77 ± 3.34 ° and 6.14 ± 6.28 °/s, respectively) compared to the placebo group (mean change: 5.13 ± 2.79 ° and 2.10 ± 5.29 °/s, respectively). Also, the mean sagittal lumbar to hip movement ratios improved more significantly in the vibration group (mean change: 0.09 ± 0.08) compared to the placebo group (mean change: 0.05 ± 0.05).

Comment

Vibration stimulation is believed to increase muscle strength and joint stability by enhancing neuromuscular activity. The vibrations stimulate the muscle spindles activating the alpha motoneurons and induce muscle contraction by stimulating the stretching reflex when alternately, at the appropriate frequency, they stimulate momentary relaxation and contraction of the muscles. This can be important for LBP patients, because most of them present spasms of the paravertebral muscles. Moreover, as previous reports have shown, vibration relaxes the muscles and alleviates the musculoskeletal pain caused by high muscle tone in adult LBP patients. Significant improvement in proprioception has also been shown following vibration stimulation of proprioceptors such as the Golgi tendon organs in adult LBP patients.

The results of the presented report confirm previously observed beneficial effects of vibrotherapy on pain relief and improvement of LBP proprioception, but for the first time also in teenage patients.

Moreover, dysfunctions in patients with LBP, which have a significant impact on the quality of life, are often caused by the limited mobility of the LS and the hips – cooperating with each other. And, as was shown in the present study, the mobility of LS during STS flexion was significantly improved under the influence of vibration in adolescent LBP patients.

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